Infant Hiv Test Poses Rights Question

In Cook County Hospital, doctors who suspect a pregnant woman of drug abuse often ask to test her newborn baby for the HIV virus so they can start preventive treatment immediately.

If the mother says no, doctors cannot overstep her rights--even if they think the decision would further endanger both mother and child.

But that policy could change by the year 2000 if federal lawmakers pass a measure that would require states to test newborns for the HIV virus. The proposal, currently being fine-tuned in Washington, has pitted health officials against advocates for civil liberties and AIDS rights before it even passes.

The fate of the measure has particular urgency in Chicago because of the number of infants born to mothers infected with HIV, the virus that causes AIDS.

One North Side woman who said she is eight months' pregnant and has been HIV positive for two years, vehemently opposes mandatory AIDS testing because she considers it an invasion of privacy.

"It's not fair for someone at DCFS to be able to find out about it and use it to take my kid away," Donna White said. "I got pregnant knowing I had the virus, but that shouldn't be held against me."

The most recent data available shows that about 150 HIV-infected women gave birth in the city in both 1993 and 1994, according to the Chicago Department of Public Health.

Since 1982, there have been 143 reported pediatric AIDS cases in the city and 12 cases reported to the suburban Cook County Health Department, according to Dr. Stephanie Smith, director of communicable diseases for the Cook County Public Health Department.

Under the pending legislation, mandatory testing of newborns would begin only in states where health officials fail to reduce the number of infected babies by 50 percent through other means, such as counseling, in which mothers follow a doctor's advice to take an HIV test during their pregnancy.

Since medical officials say counseling is a moot point for some poor women who cannot afford prenatal care, the mandatory testing component of the proposed federal measure would, in effect, work like a safety net to ensure that babies are tested.

But because the majority of women do seek prenatal care at one time or another, mandatory counseling about HIV testing is preferred to mandatory testing, which might scare some women away from hospitals altogether, said Bob Rybicki, assistant commissioner for the city Health Department.

"Counseling during the early stage of pregnancy gets the mother thinking about the potential dangers of not being tested and allows us to assess her risk factors," he said. "It's the best way to get her to make a sound decision."

Mark Ishaug, director of public policy for the AIDS Foundation of Chicago, says studies show that more than 95 percent of women in the city who are appropriately counseled agree to HIV testing if their physicians recommend it.

At issue in the often heated debate surrounding mandatory testing is whether a mother's right to privacy overrides concerns for a child's health care.

A baby who tests positive for HIV carries the mother's antibodies in its blood, and there is only a 25 percent chance that the baby will be infected, Smith said.

Positive test results would allow doctors to begin immediate drug treatment to reduce the likelihood that the virus will be transmitted to the baby, Smith said.

At the same time, the test results indicate the mother is infected with HIV, whether she wanted to be tested or not, a point of contention for the American Civil Liberties Union.

"Fundamental medical decisions should be a person's choice and not made by government decree," said Roger Leishman, an attorney for the ACLU.

State Rep. Cal Skinner (R-Crystal Lake), a longtime advocate of mandatory AIDS testing, said if testing is delayed until birth, it could already be too late to help the infant.

"You've got to test the mother during the early stages of pregnancy and give her AZT treatment then," he said. "That's the way to decrease the transmission of the virus and then the death rate."